1.1 A bill for an act
1.2 relating to human services; requiring individual pricing of phototherapy lights;
1.3 making technical changes; amending Minnesota Statutes 2024, section 256B.766.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2024, section 256B.766, is amended to read:
1.6 256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
1.7 Subdivision 1.Payment reductions for base care services effective July 1, 2009.(a)
1.8Effective for services provided on or after July 1, 2009, total payments for basic care services,
1.9shall be reduced by three percent, except that for the period July 1, 2009, through June 30,
1.102011, total payments shall be reduced by 4.5 percent for the medical assistance and general
1.11assistance medical care programs, prior to third-party liability and spenddown calculation.
1.12 Subd. 2.Classification of therapies as basic care services.Effective July 1, 2010, The
1.13commissioner shall classify physical therapy services, occupational therapy services, and
1.14speech-language pathology and related services as basic care services. The reduction in this
1.15paragraph subdivision 1 shall apply to physical therapy services, occupational therapy
1.16services, and speech-language pathology and related services provided on or after July 1,
1.172010.
1.18 Subd. 3.Payment reductions to managed care plans effective October 1, 2009.(b)
1.19Payments made to managed care plans and county-based purchasing plans shall be reduced
1.20for services provided on or after October 1, 2009, to reflect the reduction in subdivision 1
1.21effective July 1, 2009, and payments made to the plans shall be reduced effective October
1.221, 2010, to reflect the reduction in subdivision 1 effective July 1, 2010.
1Section 1.
REVISOR AGW/HL 25-0274902/05/25
State of Minnesota
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HOUSE OF REPRESENTATIVES
H. F. No. 1675
NINETY-FOURTH SESSION 2.1 Subd. 4.Temporary payment reductions effective September 1, 2011.(c) (a) Effective
2.2for services provided on or after September 1, 2011, through June 30, 2013, total payments
2.3for outpatient hospital facility fees shall be reduced by five percent from the rates in effect
2.4on August 31, 2011.
2.5 (d) (b) Effective for services provided on or after September 1, 2011, through June 30,
2.62013, total payments for ambulatory surgery centers facility fees, medical supplies and
2.7durable medical equipment not subject to a volume purchase contract, prosthetics and
2.8orthotics, renal dialysis services, laboratory services, public health nursing services, physical
2.9therapy services, occupational therapy services, speech therapy services, eyeglasses not
2.10subject to a volume purchase contract, hearing aids not subject to a volume purchase contract,
2.11and anesthesia services shall be reduced by three percent from the rates in effect on August
2.1231, 2011.
2.13 Subd. 5.Payment increases effective September 1, 2014.(e) (a) Effective for services
2.14provided on or after September 1, 2014, payments for ambulatory surgery centers facility
2.15fees, hospice services, renal dialysis services, laboratory services, public health nursing
2.16services, eyeglasses not subject to a volume purchase contract, and hearing aids not subject
2.17to a volume purchase contract shall be increased by three percent and payments for outpatient
2.18hospital facility fees shall be increased by three percent.
2.19 (b) Payments made to managed care plans and county-based purchasing plans shall not
2.20be adjusted to reflect payments under this paragraph subdivision.
2.21 Subd. 6.Temporary payment reductions effective July 1, 2014.(f) Payments for
2.22medical supplies and durable medical equipment not subject to a volume purchase contract,
2.23and prosthetics and orthotics, provided on or after July 1, 2014, through June 30, 2015, shall
2.24be decreased by .33 percent.
2.25 Subd. 7.Payment increases effective July 1, 2015.(a) Payments for medical supplies
2.26and durable medical equipment not subject to a volume purchase contract, and prosthetics
2.27and orthotics, provided on or after July 1, 2015, shall be increased by three percent from
2.28the rates as determined under paragraphs (i) and (j) subdivisions 9 and 10.
2.29 (g) (b) Effective for services provided on or after July 1, 2015, payments for outpatient
2.30hospital facility fees, medical supplies and durable medical equipment not subject to a
2.31volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified
2.32in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent
2.33from the rates in effect on June 30, 2015.
2Section 1.
REVISOR AGW/HL 25-0274902/05/25 3.1 (c) Payments made to managed care plans and county-based purchasing plans shall not
3.2be adjusted to reflect payments under this paragraph (b).
3.3 Subd. 8.Exempt services.(h) This section does not apply to physician and professional
3.4services, inpatient hospital services, family planning services, mental health services, dental
3.5services, prescription drugs, medical transportation, federally qualified health centers, rural
3.6health centers, Indian health services, and Medicare cost-sharing.
3.7 Subd. 9.Individually priced items.(i) (a) Effective for services provided on or after
3.8July 1, 2015, the following categories of medical supplies and durable medical equipment
3.9shall be individually priced items: customized and other specialized tracheostomy tubes
3.10and supplies, electric patient lifts, phototherapy lights, and durable medical equipment repair
3.11and service.
3.12 (b) This paragraph subdivision does not apply to medical supplies and durable medical
3.13equipment subject to a volume purchase contract, products subject to the preferred diabetic
3.14testing supply program, and items provided to dually eligible recipients when Medicare is
3.15the primary payer for the item.
3.16 (c) The commissioner shall not apply any medical assistance rate reductions to durable
3.17medical equipment as a result of Medicare competitive bidding.
3.18 Subd. 10.Rate increases effective July 1, 2015.(j) (a) Effective for services provided
3.19on or after July 1, 2015, medical assistance payment rates for durable medical equipment,
3.20prosthetics, orthotics, or supplies shall be increased as follows:
3.21 (1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
3.22were subject to the Medicare competitive bid that took effect in January of 2009 shall be
3.23increased by 9.5 percent; and
3.24 (2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
3.25the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
3.26that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
3.27being applied after calculation of any increased payment rate under clause (1).
3.28 This (b) Paragraph (a) does not apply to medical supplies and durable medical equipment
3.29subject to a volume purchase contract, products subject to the preferred diabetic testing
3.30supply program, items provided to dually eligible recipients when Medicare is the primary
3.31payer for the item, and individually priced items identified in paragraph (i) subdivision 9.
3.32 (c) Payments made to managed care plans and county-based purchasing plans shall not
3.33be adjusted to reflect the rate increases in this paragraph subdivision.
3Section 1.
REVISOR AGW/HL 25-0274902/05/25 4.1 Subd. 11.Rates for ventilators.(k) (a) Effective for nonpressure support ventilators
4.2provided on or after January 1, 2016, the rate shall be the lower of the submitted charge or
4.3the Medicare fee schedule rate.
4.4 (b) Effective for pressure support ventilators provided on or after January 1, 2016, the
4.5rate shall be the lower of the submitted charge or 47 percent above the Medicare fee schedule
4.6rate.
4.7 (c) For payments made in accordance with this paragraph subdivision, if, and to the
4.8extent that, the commissioner identifies that the state has received federal financial
4.9participation for ventilators in excess of the amount allowed effective January 1, 2018,
4.10under United States Code, title 42, section 1396b(i)(27), the state shall repay the excess
4.11amount to the Centers for Medicare and Medicaid Services with state funds and maintain
4.12the full payment rate under this paragraph subdivision.
4.13 Subd. 12.Rates subject to the upper payment limit.(l) Payment rates for durable
4.14medical equipment, prosthetics, orthotics or supplies, that are subject to the upper payment
4.15limit in accordance with section 1903(i)(27) of the Social Security Act, shall be paid the
4.16Medicare rate. Rate increases provided in this chapter shall not be applied to the items listed
4.17in this paragraph subdivision.
4.18 Subd. 13.Temporary rates for enteral nutrition and supplies.(m) (a) For dates of
4.19service on or after July 1, 2023, through June 30, 2025, enteral nutrition and supplies must
4.20be paid according to this paragraph subdivision. If sufficient data exists for a product or
4.21supply, payment must be based upon the 50th percentile of the usual and customary charges
4.22per product code submitted to the commissioner, using only charges submitted per unit.
4.23Increases in rates resulting from the 50th percentile payment method must not exceed 150
4.24percent of the previous fiscal year's rate per code and product combination. Data are sufficient
4.25if: (1) the commissioner has at least 100 paid claim lines by at least ten different providers
4.26for a given product or supply; or (2) in the absence of the data in clause (1), the commissioner
4.27has at least 20 claim lines by at least five different providers for a product or supply that
4.28does not meet the requirements of clause (1). If sufficient data are not available to calculate
4.29the 50th percentile for enteral products or supplies, the payment rate must be the payment
4.30rate in effect on June 30, 2023.
4.31 (b) This subdivision expires June 30, 2024.
4.32 Subd. 14.Rates for enteral nutrition and supplies.(n) For dates of service on or after
4.33July 1, 2025, enteral nutrition and supplies must be paid according to this paragraph
4.34subdivision and updated annually each January 1. If sufficient data exists for a product or
4Section 1.
REVISOR AGW/HL 25-0274902/05/25 5.1supply, payment must be based upon the 50th percentile of the usual and customary charges
5.2per product code submitted to the commissioner for the previous calendar year, using only
5.3charges submitted per unit. Increases in rates resulting from the 50th percentile payment
5.4method must not exceed 150 percent of the previous year's rate per code and product
5.5combination. Data are sufficient if: (1) the commissioner has at least 100 paid claim lines
5.6by at least ten different providers for a given product or supply; or (2) in the absence of the
5.7data in clause (1), the commissioner has at least 20 claim lines by at least five different
5.8providers for a product or supply that does not meet the requirements of clause (1). If
5.9sufficient data are not available to calculate the 50th percentile for enteral products or
5.10supplies, the payment must be the manufacturer's suggested retail price of that product or
5.11supply minus 20 percent. If the manufacturer's suggested retail price is not available, payment
5.12must be the actual acquisition cost of that product or supply plus 20 percent.
5Section 1.
REVISOR AGW/HL 25-0274902/05/25